


Doctors of S.H.I.E.L.D. Year One: Pieces Solving a Puzzle

by kitlee625, Sarahastro



Series: Doctors of S.H.I.E.L.D. [1]
Category: Agents of S.H.I.E.L.D. (TV), Marvel Cinematic Universe
Genre: Alternate Universe, F/M
Language: English
Status: In-Progress
Published: 2017-08-15
Updated: 2017-08-31
Packaged: 2018-12-15 18:08:41
Rating: General Audiences
Warnings: No Archive Warnings Apply
Chapters: 3
Words: 8,997
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/11811426
Author URL: https://archiveofourown.org/users/kitlee625/pseuds/kitlee625, https://archiveofourown.org/users/Sarahastro/pseuds/Sarahastro
Summary: A year after a near-fatal heart attack, Dr. Phil Coulson decides to dedicate himself to improving the residency program at S.H.I.E.L.D. Memorial Hospital with the help of his longtime friend and colleague Dr. Melinda May.





	1. Chapter 1

**Author's Note:**

> This is a rewrite of our series Doctors of S.H.I.E.L.D., which we began writing during Season 1 of Agents of S.H.I.E.L.D. At the time, we were trying to adapt each episode to a medical setting, and as the episodes moved away from a Case of the Week format, it became increasingly difficult to write them. But we loved the idea, and we've decided to give it another try. We are keeping the original series up on AO3 for the sake of nostalgia, now called "Doctors AU."
> 
> Each story in the series will be loosely inspired by a season of Agents of S.H.I.E.L.D. and will cover one year at S.H.I.E.L.D. Memorial Hospital.

Dr. Phil Coulson sighs and stares at the stack of applications piled on his desk. All of his colleagues had warned him against taking on the position of residency director at S.H.I.E.L.D., but at the time he had ignored them. Now, though, he is starting to think they were correct. S.H.I.E.L.D. Memorial Hospital is a world-famous biomedical research facility, but its teaching hospital is essentially an afterthought. It has never attracted the best residents, and most of the faculty had trained elsewhere, including him.

But one year ago, those residents had saved his life after he collapsed in his office with a massive heart attack. He had spent weeks heavily sedated in the Intensive Care Unit, and somehow they had kept him alive long enough to get a heart transplant.

When he had finally woken up, the first person he saw was his friend and mentor, Dr. Nick Fury, standing over him.

“Looks like you’re going to make it,” Fury had said gruffly.

“What happened?” Coulson had asked.

“Heart attack. You were in cardiogenic shock. We had to do a transplant.

Coulson had reached towards his chest. A huge bandage stretched from his clavicle to just below his rib cage. On both sides, electrodes and wires were connected to an array of beeping monitors next to the bed. Intellectually, he had known what was going on -- he has had literally hundreds if not thousands of patients in the same state -- but seeing himself like that had been hard to process.

“Thanks,” he had finally said.

“Just get better.”

It had taken weeks in the hospital and months recovering at home before he was finally strong enough to return to work. Fury had held his position as professor of medicine, but during his absence he had been lost his position as chief of cardiology to Dr. Tony Stark. It had not come as a surprise -- Stark had been gunning for the job ever since he had arrived from the Cleveland Clinic.

At first he tried to take advantage of his lighter responsibilities to revive his research career. At one point, he had been a very promising researcher in preventative cardiology. However, he didn’t feel the same satisfaction that he once did. It felt too detached from patient care. He no longer had the patience to run clinical trials and analyze data hoping to find the next big breakthrough. He wanted to be on the front lines of patient care.

He changed his schedule to spend more on the wards, but although he enjoyed seeing patients, he found himself frustrated with the residents. They were a far cry from what he remembered from his own training. Most of them had come to S.H.I.E.L.D. solely to get involved in research and were uncomfortable actually taking care of patients.

Then one day he received an email that the current residency director was stepping down. The department of medicine was eagerly searching for his replacement.

Before his heart attack, he would have deleted the email without a second thought. Becoming residency director had never been something on his radar. But he couldn’t stop thinking about it. In the end, he had submitted an application. During the interview, Fury had looked at him like he was crazy. But in the end, Fury had given Coulson the job. He was by far the most qualified candidate.

“Good luck. You’re going to need it,” Fury had told him.

*****

Dr. Melinda May is going over her grant application for what feels like the hundredth time when there is a knock on her office door. She glares at her computer screen, willing the person on the other side to go away. The grant deadline is only two days away, and she does not have time for any interruptions. She wonders who would be bothering her so late at night. Her colleagues rarely come by her office, and almost everyone else went home hours ago.

The person knocks again, a little louder, then opens the door without waiting for a response. “May.”

She recognizes Coulson’s voice immediately. “No.”

“So you do read your emails.” His voice is more amused than annoyed.

She swivels around in her chair to face him. “I’m a scientist, not an administrator. I don’t have time for this.”

“It won’t be that much time,” he assures her. “Just helping me with scheduling, supervising the residents on the wards--”

She interrupts him. “Then you don’t want me.” 

She tries to keep her voice flat and emotionless, but she must have failed because Coulson looks at her sadly. “I do. I need you, Melinda. You’re one of the best doctors I know.” He gives her a small smile. “Remember our residency? It was hard, but it taught me what it means to be a doctor. I want to reform the residency program here, make it more like what we had. And there’s no one I trust more to do it with me than you.”

A wave of nostalgia washes over her, as the memories bubble to the surface. She had practically lived at the hospital in those days, and looking back, she wonders how she had survived. But she still thinks of that time as some of the best years of her life, and a big part of that had been working with the other residents, especially Coulson. He had always been there for her when she needed him. If he really wants to do this, she can’t let him do it alone.

Against her better judgment, she nods slowly, and his smile widens.

*****

Coulson is even more nervous on Match Day than he had been when he was a medical student waiting to see where he would be doing his residency. He checks his email every few minutes, wondering whether they will be able to fill all the spots in their residency class. When the email finally arrives, he is pleasantly surprised to find that they only have one empty spot. That meant they only needed to pick one candidate from the pool of medical students who had not already gotten a residency through the match.

As he and May sift through applications, he says, “This is better than I expected. Last year they had to fill half a dozen.”

“We only have a day to fill it.” She flips through an application, sighs, and closes the folder. “Some of these people barely graduated medical school.”

“There are some good candidates here.” He finishes reviewing an application and puts it in the maybe pile. They are sorting the applications into three piles: yes, maybe, and no. So far there are a handful of maybes and a lot of nos. Neither of them have put a single application in the yes pile.

Something about the next application makes it stand out to him. He reads it twice, then hands it to May. “Look at this one.”

She reads it, then closes the folder. “No.”

“She had good board scores and good evaluations for internal medicine.”

“She didn’t apply in internal medicine. She applied in radiology. If we let her in, she’ll just leave next year to take a residency in radiology.”

“We’ll convince her not to. Her evaluations all mention how good she is with patients. Someone like that belongs in internal medicine, not sitting in a dark room staring at X-rays.”

She gives him a pointed look. “That’s up to her, not you.”

“She’s applied for our internal medicine spot, and she’s the best candidate we have. She’s in.”


	2. Chapter 2

The night before her first day of intern year, Daisy can’t sleep. She could blame it on the fact that she’s in a new apartment in an unfamiliar city, or that she’s still sore from assembling her Ikea furniture by herself earlier that day. But even putting aside those two annoyances, her mind is racing too much to sleep. She has dreamed of being a doctor almost her whole life, and tomorrow is her first day as Dr. Daisy Johnson.

This isn’t exactly how she imagined it happening though. She had planned on becoming a radiologist, not an internist, where she would spend her days analyzing images rather than interacting with people. She likes people, but she prefers dealing with them outside of hospitals. In the hospital, people become messy and complicated. Hopefully, she can reapply in a few months and then transfer directly into a radiology program next year.

She tosses and turns all night, and in the morning, she feels jittery as she gets ready for work and heads to the hospital. The day before had been orientation, but she barely remembers any of it. The hospital is like a maze, and she gets lost several times trying to find her way to the team room. At last she finds a nurse who points her in the right direction.

When she gets to the office, there are already three people inside. They all turn to look at her, and the taller man frowns at her. “You’re late.”

Daisy crosses her arms and tries to hide her embarrassment. “This place is like a maze. I’ve been wandering around for like ten minutes.”

He does not even acknowledge her excuse. He points to the large whiteboard, where there are three columns of patient names labeled A, B, and C. “We’re on call today, so the service is pretty light. You’re intern C. Read about your patients before you start getting admissions.”

“Wait -- I’m on call today?”

He gives her another frown. “Didn’t you check the schedule?”

“I couldn’t. My internet doesn’t get set up until Friday.”

He gives her a withering look. “Well you are. Now get started reading about your patients. We’re rounding with our attending in fifteen minutes.”

The room is small, barely large enough to fit all four of them. There is a round table pushed in the far corner, and a long table along the right side on which are perched three computers. The other two people have been silently staring at their computers, but when Daisy sits down next to the young woman, she gives Daisy a friendly smile.

“Hi, I’m Jemma. What’s your name?”

“Daisy. Are you an intern too?”

“Yes. So’s Fitz.” The man next to her mumbled a hello without taking his eyes off his computer.

Daisy lowers her voice. “So that guy’s our resident?”

“Yes. His name is Grant Ward.”

“He seems intense.”

Jemma gives her a sympathetic look. “He was the same way when Fitz and I got here.”

Daisy makes a face at the thought of being stuck in this tiny room with him supervising her for the next month.

Jemma goes back to her computer, and Daisy logs into the medical record system. At least she can figure that out quickly. She’s always been good with computers.

As she is reading about her patients, the door opens, and Dr. Coulson walks in. Daisy recognizes him from orientation. She is a little intimidated knowing that their boss is her first attending. It has been a long time since she has done any real clinical work. She spent the last half of her senior year of medical school in Costa Rica, exploring the area and partying with the other volunteers.

He smiles at the interns. “How’s it going? Daisy, Jemma, Fitz, are you all learning the ropes?”

“It’s fine, sir,” Ward says quickly before the three of them can answer. “We’re ready to round.”

Coulson looks surprised. “Already? It’s the first day. I thought we could skip formal rounds today, and see everyone together as a team. Give the interns some background on their patients.”

Fitz and Simmons look relieved, but Ward looks disappointed. Daisy wonders if he had been looking forward to quizzing them on rounds. Before they can get started though, Daisy’s pager beeps. She flips it open and reads:   
PT ASSIGN: Peterson MRN: 20130924 LOC: ED08 CC: SOB

“I got a new admission.”

Ward frowns. He glances at his watch, and then at Coulson. “I can eyeball him before rounds if you don’t mind waiting, Dr. Coulson.”

“I think Daisy can handle it,” Coulson says. “I want the interns to take the lead on the patients.” He looks at the board. “Looks like Daisy only has a single patient, and from the sign out, he’s just waiting to go to a rehab. We can see him last, so Daisy has time to see this new patient first.”

Ward nods, but he looks concerned, like he doesn’t trust her to handle it on her own. “Page me as soon as you’re done, so we can go over admission orders,” he tells Daisy.

“Okay. Where’s the ED?” Daisy asks.

Ward sighs. “Didn’t you get a tour yesterday?”

“Yeah, but I barely even know where I am now.”

“I know where the ED is,” Jemma offers quickly. “I can take her. I have to run down to the lab to drop off my patient’s sample anyway.”

Coulson looks pleased. “Thanks, Jemma. We’ll start with Fitz’s patients.”

“Get back up here as soon as you’re done,” Ward says.

The sample that Jemma has to deliver turns out to be a large orange jug. Jemma beams when the nurse hands it to her.

“What’s that?” Daisy asks as she follows Jemma down the hall to the service elevators.

“It’s my patient’s urine.”

Daisy makes a face. “Why?”

They get into the elevator, and Jemma hits the button for the basement. “We’re testing for amyloid.”

“Isn’t that like really rare?”

Jemma’s voice rises with excitement. “Yes, but he’s the perfect case. He has kidney and liver injury and evidence of an infiltrative disease on his echocardiogram.”

Daisy can’t help but be impressed. “Wow, nice call.” She vaguely remembers learning this in medical school, but there’s no way she could have put the pieces together and come up with the diagnosis on her first day. She wonders how Jemma can already be so far ahead of her.

“Thanks,” Jemma says, “but it wasn’t me. Dr. Coulson paged me this morning and recommended that we look for it. I think he was looking up all the patients before rounds.”

Hearing that makes Daisy feel a little better. Jemma seems so smart and put together. She didn’t show up late, and she already knows her way around. It’s nice to be reminded that they both have a lot to learn, and that there’s someone looking over their shoulders to make sure they don’t miss anything. 

*****

The ED can only be described as chaotic. It is set up in pods, with patients sequestered in a half dozen interconnecting rooms. It takes several minutes of wandering around before Daisy finds a curtained off area with a large number 8 hanging above it. A doctor standing outside the curtain looks relieved when he spots her.

“Are you admitting bed 8?”

“Peterson, right? Yeah. I’m Daisy.”

“Good, maybe you can talk some sense into him.”

Daisy frowns. “What do you mean?”

“He doesn’t want to be admitted. He won’t even admit that he’s sick.”

In her rush to get down to the ED, Daisy had forgotten to look up Mr. Peterson’s chart, but she doesn’t want to admit that to the ED doctor. “Okay, well, I’ll take care of it.”

After the ED doctor goes to see another patient, Daisy finds a computer and pulls up Mr. Peterson’s information. He’s doesn’t have any noteworthy past medical history, but for the past few weeks, he’s noted leg swelling, shortness of breath, and fatigue. His labs show both liver and kidney failure, but there’s nothing in his history to explain why.

She spends a few more minutes trying to gather clues from his chart, but when she doesn’t find anything helpful, she gives up and goes to talk to him. He is sitting on a gurney in a curtained off area. He has been staring at his phone, but as soon as she pulls the curtain aside, he looks up at her anxiously.

“Are you the doctor?”

“Yeah. I mean, I’m Dr. Johnson. I’ll be admitting you to the hospital.”

“I need to talk to you. There’s been some kind of mistake. I don’t need to be in the hospital. I’m not sick.” He speaks quickly, the words rushing together too fast for Daisy to get in a word edgewise. “I’ve got to get out of here. I’ve got to pick up my son. I’m all he’s got now, and he’s going to be worried --”

“Mr. Peterson--” Daisy interrupts.

“Mike,” he corrects her.

Daisy takes a deep breath and tries to project calmness and confidence. “Mike,” she says firmly, “I’m sorry, but you can’t leave the hospital. You are very sick.”

“But I feel fine.”

“I thought you were having shortness of breath,” Daisy says, but Mike shakes his head dismissively.

“It’s not that big a deal. I wouldn’t have even come except my sister made me. But I’ve been here for hours, and you guys haven’t done anything, so--”

Daisy wants to be understanding, but she is having a hard time staying patient. “Mike,” she interrupts, “you are sick. You have kidney and liver failure, and you have to be admitted so we can figure out what’s wrong, and fix you. If you leave now, you could get a lot sicker and even die.”

Mike falls silent. He stares at her with a stunned expression on his face. It is clear that in all the hours he’s spent in the ED, no one has told him this. Finally he asks, “My kidneys and liver aren’t working? Why not?”

“I don’t know,” Daisy admits.

“What are you going to do about this? Is this permanent? I had an uncle who was on dialysis for years -- is that going to be me?”

Daisy’s head is spinning. She has no idea what’s wrong with Mike, but she doesn’t want to admit that to him. “I need to run some tests, and then we can talk about what’s going to happen next.”

Her pager beeps, interrupting them, and she flips it open. She’s gotten three messages just in the time she’s been down in the ED. Two are from Ward, wanting to know if she’s done with Mike and ready to round on her patient upstairs. The third is another new admission, this time a patient who is coming from home directly to the hospital. 

“I’m sorry Mike, but I have to return these pages. I’m going to order some tests to figure out what’s going on with your kidneys and liver, and then I’ll be back later. We can talk more then.”

Mike looks unhappy, but he doesn’t argue with her. He just folds his arms across his chest and nods.

*****

The day rushes by in a blur. Daisy is pulled from one thing to another without a single minute to rest. After talking to Mike in the ED, she goes upstairs only to find that they have already rounded on her patient, who Coulson wants to discharge. It takes over an hour to finish the paperwork with Ward is standing over her shoulder the whole time.

In the middle of that, her second new admission arrives. She hopes that once she’s done with the second admission, she can circle back around and see Mike, but she doesn’t get the chance. She gets her third admission of the day, and then it’s already time for sign out. Fitz, Jemma, and Ward will all be heading home for the night, while Daisy stays overnight in the hospital, doing admissions and covering their patients. Ward looks very uncomfortable as Fitz and Jemma tell her about their patients, and he keeps interrupting to correct them or to add things to Daisy’s to-do-list. By the end, her list is almost unintelligible.

Ward stares at her list, and then back at Daisy. “I’ll be back at 5. Call me if you need anything. And there’s a resident here overnight if you need help. Don’t hesitate to call her too.”

“Thanks,” Daisy says. She can tell that Ward doesn’t have a lot of faith in her, and even though it annoys her, a small part of her is relieved that there’s someone making sure she doesn’t screw up too badly.

It is after dinner time when Ward, Fitz, and Jemma finally leave, and Daisy takes a few minutes to get something to eat while she goes through her new admissions in more detail. The second and third admissions are pretty straightforward, but Mike is a complete mystery. She spends hours reading articles about the causes of liver and kidney failure and ordering more and more tests. However, it is hard to concentrate because now that Fitz and Jemma are gone, Daisy is getting a steady stream of pages about their patients. Every few minutes there is something new. None of it is critical or even urgent, but it’s invasive enough that she keeps losing her train of thought.

Things finally settle down after 2 AM, and she has almost an hour uninterrupted to work on her presentations for rounds. By 4 AM, she has finished up her second and third admissions, and she is just going back to tackle Mike’s case when she gets a page. Mike Peterson wants to talk to her.

She groans and gets to her feet. She should have gone back to talk to him hours ago, but as it got later and later, she figured that he would just go to sleep, and she could talk to him in the morning. After all her research, she still doesn’t have anything definitive to report. There are dozens of possible explanations for his liver and kidney failure, and the tests she ordered are still being run.

When she gets to his room, he is pacing anxiously. When he sees her, he asks, “What’s wrong with me?”

Daisy is surprised by his directness. “I don’t know.”

“Someone came by an hour ago and took a bunch of tubes of blood. Why? What did that show?”

“I don’t know. I mean, they’re still in the lab.” 

The words sound empty even to her. Mike stares at her, not so much angry as disappointed and scared. “I can’t afford to stay in the hospital indefinitely. I have to get a job and take care of my son. How long am I going to be here anyway?” Daisy hesitates, and before she can answer, he says, “Let me guess -- you don’t know.”

Daisy crosses her arms across her chest and tries to sound authoritative. “Mr. Peterson, the lab tests should be back in the next few hours or days. We’ll know more then. I’ll be back to talk to you in the morning with my attending.”

In a small voice, Mike asks, “Am I going to die?”

She doesn’t want to admit that she doesn’t know that either. “We’ll know more tomorrow,” she tells him. “After we get some of these results back.”

*****

When she leaves Mike’s room, all she wants to do is go to sleep, but instead she forces herself to read more articles about liver and kidney failure until her head is spinning with information. There are still too many possibilities on the table to answer any of his questions. She only hopes that something will be revealed in all the tests she ordered.

She must have fallen asleep in front of her computer, because the next thing she knows, Ward is shaking her awake.

“Hey,” he says, “how was your night?”

“Long. What time is it?”

“Five.” 

Daisy rubs her eyes and yawns. “I need some coffee.”

“How are the patients?”

“They’re fine. But the nurses paged me about every little thing last night. Stuff that wasn’t urgent, or wanting to confirm orders that Fitz and Jemma had put in.”

“What about your new patients?”

“They’re okay. But I’m not sure what’s wrong with Mr. Peterson. He’s got liver and kidney failure, but I’m not sure why. I sent a big workup, but it’s not back yet.”

“Common things are common, he probably has hepatitis C or something. Does he use drugs?”

“No. He doesn’t have any risk factors,” Daisy says. 

“Is he lying? Don’t forget, patients lie all the time.”

“I don’t think so. He seems like a reliable guy,” she says. Just then, her pager goes off. She reads it and groans. “Mike left.”

“Not so reliable then,” Ward says.

“What should I do?” Daisy asks.

“When patients elope, we have to hold the bed for four hours before it can be released.”

“That’s not what I mean. What should I do for Mike?”

Ward shrugs. “He made the decision to leave.”

That answer is not what Daisy had been looking for. She wants to know some way to help Mike, especially because she feels responsible for his leaving. She keeps replaying their conversation last night, how scared Mike was, and how clueless she had been. She wishes that she could go back in time and make this right.

Fitz and Jemma arrive not long after Ward, and she updates them on their patients, still thinking of ways to help Mike. She could try calling him, but she’s not sure what she could say that would convince him to come back and let her help him.

The morning flies by, and before she knows it, Coulson has arrived for rounds. He hands her a cup of coffee. “How was your first night on call?”

He looks so kind and genuinely concerned that she blurts out, “Terrible. Mr. Peterson left AMA.”

Coulson asks, “What happened?”

“It’s my fault. He came in with liver and kidney failure, and I couldn’t figure it out. He said he couldn’t afford to stay in the hospital, but I just kept brushing him off.”

“It’s okay, Daisy. These things happen. The important thing is that we figure out how we can help this patient. Does he need to be in the hospital? Or can we set him up with an outpatient appointment to follow up on this?”

“I think he needs to be here. I don’t know why he has liver and kidney failure, but he’s pretty symptomatic.”

“Okay. Then we’re going to have to figure out a way to contact him and try to convince him to come back.” He glances at the clock. “We’ll round on the other patients now, and then after rounds, you and I will reach out to Mr. Peterson.”

*****

However, when Daisy tries calling Mr. Peterson after rounds, the number listed for him has been disconnected. She looks over at Coulson for help, and sees him reading through Mr. Peterson’s chart.

“No answer. I can’t even leave a message.”

“You’re right, he’s very sick. This really isn’t something that we can sit on. We’re going to have to try to find him another way. Does he have any other family that we can reach out to?”

His sister is listed as his emergency contact. This number rings, but she doesn’t pick up, and her mailbox is full. 

“That address is only a couple of blocks from here,” Coulson says. “I’ll drive over there and see if she’s home.”

“I can do it,” Daisy says.

He shakes his head. “You should get some rest. You’ve been up too long already.”

She feels too guilty to let Coulson clean up her mess. “This is my fault. I should fix it.”

“This isn’t your fault,” he says gently. “These things happen sometimes.” He looks at her and then at the clock. “If you really want to go, we can go together now. I’ll drive.”

*****

They walked to the parking garage in silence, but Daisy could not help but snicker a little when she saw his vintage bright red Corvette.

“Nice car,” she smirks.

“Thanks.”

Daisy falls asleep almost as soon as they leave the parking lot. When she wakes up, they are parked outside a house and Coulson is shaking her shoulder gently.

“We’re here. I’ll do the talking,” he says.

A young woman answers the door. “Hello, I’m Dr. Coulson from S.H.I.E.L.D. Memorial Hospital. Is Mike Peterson here?”

“No. He came by early this morning to pick up his son. They left a couple of hours ago.” She frowns. “Is Mike alright?”

“We need to speak with him. Do you know where they went?”

“Home. They have an apartment in Takoma Park.”

“Can you give us his address?” The woman gives them a suspicious look, and for a moment Daisy is concerned that she won’t. But Coulson’s calm, confident demeanor seems to work, and she nods.

But when they get to the apartment in Takoma Park, there is no one inside. Finally a neighbor comes out and tells them that the Petersons had moved out two weeks ago.

“Do you know where they went?” Coulson asked.

“No. But they left behind a lot of their stuff.”

As they head back to his car, Daisy says, “Mr. Peterson mentioned that he’d lost his job.”

Coulson checks his watch. “We should check at some nearby homeless shelters. They’ll be opening their doors for the evening soon.”

They find him at the second homeless shelter they try. “That’s him,” Daisy says. He is holding hands with a little boy, and when he sees them, he looks nervous.

Coulson walks up to him without hesitation. “Mr. Peterson, I’m Dr. Coulson from S.H.I.E.L.D. Memorial. Do you have a minute?”

“What are you doing here?”

“We wanted to talk about your recent hospital visit.”

Mike shifts back and forth nervously. “Look, I know I shouldn’t have just run off like that without paying my bill, but I couldn’t stay there any longer. I have to take care of my son.”

“We’re not here about the bill. We’re here about your health.”

“I’m fine,” Mike insists. He glances at his son, who is looking curiously at Coulson and Daisy. “There’s nothing to worry about.” He sounds like he is trying to reassure both himself and his son.

“Mr. Peterson, we need to figure out what’s wrong with you before you get sicker.”

Mike looks at Daisy and then at Coulson. “So you don’t know what’s wrong with me either?”

“You have an injury to your liver and kidneys,” Coulson explains. “There’s a number of things that can cause that, and there are tests that we can do to figure it out. Depending on what has caused this injury, you may need specific medicines. Either way, you’ll need medicine to help manage the symptoms, like your shortness of breath and fatigue.”

Mike shakes his head. “I don’t have time to be sick now. I need to get a job and take care of my son. It’s just the two of us now.”

“How long have you been staying here?” Coulson asks.

“A few weeks. I lost my job a few months ago. I’ve been trying to find work, but no one’s hiring. How am I going to get work if I’m sick?”

“Is there someone who could help? We went by your sister’s house looking for you. She didn’t know you’d lost your apartment.”

Mike shakes his head vigorously. “I don’t want her to know. I can handle this on my own.”

“Mr. Peterson, everyone needs help sometimes. We wouldn’t be here if we didn’t think this was important. If you don’t get this evaluated, you could get a lot sicker. But I think that we can help you if you come back to the hospital with us.”

Mike looks down at his son. He seems to be considering Coulson’s words. “How long would I need to be in the hospital?”

“Probably a few days. While you’re there, we can have our social worker work with you as well to set you up with resources until you get back on your feet.”

Mike is silent for a long time. Then he nods. “Okay. I’ll drop off Ace at my sister’s and come back to the hospital.”

Coulson looks relieved. “Thank you. You can just go straight back to your old room.”

Before they go back in the car, Coulson calls bed management to make sure that Mike’s old room is waiting for him. On the drive back, Daisy struggles not to fall asleep again. This has been the longest two days of her life. 

“Thanks for coming with me,” Coulson says.

“I should be thanking you,” Daisy says. “How were you able to do that?”

“Do what?”

“Get through to Mike. I tried to tell him the same stuff that you did, but it’s like he didn’t believe me.”

“It’s hard. Connecting with patients, that’s one of the hardest parts of the job, but also the most rewarding. With time and experience, you’ll learn your own style for connecting with people.” They pause at a red light, and Coulson looks at her. “You did a good job today. Not everyone would have come with me after working for 30 hours straight.” He checks his watch. “You probably shouldn’t be driving home after all that. I’ll drop you off at your place. Just take a cab in tomorrow, and you can get it reimbursed by the department.”

After she gives him her address, she does fall asleep, and doesn’t wake up until they arrive at her apartment. She grabs her stuff and climbs out of the car.

“Thanks for the ride,” she says.

Coulson nods. “Not a problem. Get some sleep. I’ll see you back at the hospital in 16 hours.”


	3. Chapter 3

Jemma sighs when she gets back to the office to find Fitz there with a cup of tea from their favorite tea shop. Being on call is slowly getting easier, but she still feels a rush of relief when her shift ends and she can finally go home.

“How was your night?” he asks, handing her the tea.

“Not too bad. It wasn’t too busy, and I even managed to get a few minutes of sleep. Oh, and guess who I met? Dr. Stark!”

“Really? Why?” Fitz asks.

“I admitted a patient whose stent was all clogged up. Dr. Stark did the angioplasty on the patient.”

“What did he say?”

“Well, he was only here for a few minutes, but he told me not to kill the patient after he’d gone to the trouble of saving his life.”

“I can’t believe he did the case himself. I would have assumed he was far too busy between with his research,” Fitz says.

Jemma can tell by the way Fitz is scowling that he is jealous that he didn’t get to meet Dr. Stark. “He’s on service right now, so maybe he’ll do caths on more of our patients.”

“Who’s that?” Daisy asks, coming into the office.

“Dr. Stark,” Jemma says. “I met him yesterday after he did a cath on one of my new admissions.”

“Who’s Dr. Stark?” she asks. 

“How do you not know who Dr. Stark is?” Fitz blurts out. “He’s the chairman of cardiology. He’s done a lot of cutting edge research on percutaneous valve replacements.”

Daisy rolls her eyes.

“He’s very active as chairman of cardiology,” Jemma jumps in. “Moreso than I heard Coulson was when was chair.”

“Coulson used to be chairman of cardiology?” Daisy asks.

“Before my heart attack.” The interns turn to see Coulson and Ward standing in the doorway.

“You had a heart attack?” Daisy asks.

“Did they have to put in a stent?” Simmons asks. “Or perform bypass surgery?”

“No, they gave me a new heart.” Stunned, the interns stare blankly at him, but he doesn’t seem to notice. “Ready for rounds?”

Simmons has put a lot of effort into her new admissions. Since Coulson is a cardiologist, she is sure to be as thorough as possible when presenting the heart attack patient, Mr. Leal. Coulson seems impressed, and even Ward doesn’t offer any meaningful corrections.

“Good job, Simmons,” Coulson says. “Now why do you think this happened?”

“It’s too early to be normal buildup of plaque in the artery. He must have stopped taking his Plavix and gotten an acute in-stent thrombosis.”

“But he said that he took it exactly as prescribed and never missed a dose,” Coulson reminds her.

Ward jumps in. “Second rule of medicine: all patients lie.”

Coulson frowns. “I know that’s a common perspective, but I want to break us of the habit of always assuming patients are lying or at fault. Why else might his stent have gotten clogged?”

Simmons looks flustered. She hadn’t prepared for this line of questioning. “It was just put in a few weeks ago. It shouldn’t have if he were taking his Plavix like he was supposed to.”

“But it did. Think about it and get back to me. He’ll need to be here a few days before he’ll be healthy enough to go home. Even though Dr. Stark opened up the blockage, it caused a heart attack that weakened his heart enough to put him into heart failure. We need to stabilize him before he can be discharged.”

“Give him diuretics and wean him off the supplemental oxygen,” Ward tells Simmons. “And get the records from his cardiologist. They should say whether he was taking his Plavix or not.”

*****

As Daisy is heading back to the office after checking on one of her patients, she sees Simmons and Fitz in the hallway facing down a very angry woman.

“I am not going to allow an intern to hold my patient hostage. He needs to be transferred to Fairfax General immediately.”

“But Dr. Reyes, he’s still on supplemental oxygen --” Simmons says.

“Our resident said he needs to get off it before he can leave,” Fitz says.

“Your resident said? Are you saying that you don’t know how to treat him?”

“We can page our resident,” Daisy says, “and then you can talk to him yourself.”

Simmons and Fitz nod vigorously, but Reyes just glares at Daisy. “I am not going to waste my time arguing with a resident.”

“What’s going on here?” Coulson asks.

Everyone immediately stops talking and turns to look at him. Simmons and Fitz still look nervous, but Daisy lets out an involuntary sigh of relief.

As soon as Reyes sees him, she uncrosses her arms. “Philip.”

He looks amused. “I heard that a cardiologist from another hospital was harassing my interns, but I didn’t expect it to be you.”

“Your interns have my patient, Mr. Leal. I want him transferred to Fairfax General.”

Coulson looks at Simmons. “How is he?”

“I gave him diuretics like Ward said, but he’s still not off the oxygen.”

Coulson turns back to Reyes. “It sounds like he’s not healthy enough to be transferred.”

“He’s stable. He’ll be fine for the ambulance ride.”

“That doesn’t mean that he should be moved. My residents are taking good care of him here.”

“I know him better. He’s been under my care for months.”

“Then send over the files so my team can get up to speed.” He smiles at her. “Sorry you wasted a trip over here. Why don’t I buy you a cup of coffee?”

She gives him a long appraising look, then smiles a little. Daisy starts to laugh but covers it with a cough.

“Alright. I’ll call my hospital and tell them to send over his chart right away.”

*****

When Coulson orders a doughnut along with his coffee, Reyes gives him a pointed look. “Should you really be eating that? I heard about your heart attack.”

He sighs. “It’s a lot easier giving that kind of advice than following it.”

“Well you look good.”

“I’ve been working out.” They sit down at a small table. “I heard you got promoted to chairman of cardiology. Congratulations.”

“Thank you. What about you? I don’t remember you spending a lot of time with interns.”

“I just took over as residency director.”

She raises her eyebrows at him. “Residency director? That doesn’t sound like the Philip I remember. You cared more about doing research than training residents.”

He shrugs. “I’ve changed. I want to make this program into one of the best. These residents have a lot of potential. They just need the right teachers.”

“And you’re the right one to teach them?” The look on her face is more of a smirk than a smile. “Or is it about something else? You often talked about how much you loved your residency.”

“I had some good times.”

“And now you’ve abandoned your research to take a new job working with young residents. It sounds to me like you’re having a midlife crisis.”

Coulson leans back in his chair and crosses his arms. “Why exactly did you come over here, Camilla?”

“I was checking up on my patient.”

“You could have called. You didn’t have to come over here in person.”

She shrugs and smiles at him flirtatiously. “Maybe I just wanted an excuse to see you.”

“I doubt that.” He picks up his coffee and doughnut. “Mr. Leal is our patient now, and he will be staying here until we decide he is healthy enough to be discharged.”

*****

Before Coulson leaves for the day, May comes by his office so that they can go over all of the patients. He has meetings all day tomorrow, so May has agreed to cover the wards for him. As he tells her about the patients, he inadvertently yawns, and May frowns.

“You look tired. Are you getting sick?”

He shakes his head. “I just haven’t been getting a lot of sleep. I’d forgotten what it’s like being on with new residents. I have to check everything they do.”

May still looks concerned. “Are you sure you want to cover the wards for the whole month? I can rearrange my schedule and take over for the last weeks.”

“I’ll be okay. I mean, we did this for an entire year when we were chiefs together.” He smiles fondly at the memory.

“That was a long time ago,” May reminds him. “We were a lot younger then. And even then it wasn’t exactly easy.”

“It wasn’t, but in some ways it was the most rewarding year of my life. I was doing something important -- helping patients, teaching the residents how to be doctors --”

May rolls her eyes. “-- sleeping in my office, crying in my car from exhaustion.” She gives him a pointed look. “You can make a difference without working yourself to death.”

“I suppose that’s true.” He thinks about his heart attack, how he had ignored his own health for years in favor of his career, and grimaces. “Although I don’t think I’ve ever been good at that.”

He wonders if May is thinking of the same thing, because she looks worried and places her hand over his. They sit in silence for a moment, and then he says, “I’m really fine, May. I’ll let you know if I need you need to take over the service for more than just tomorrow.”

“So how is the team? Anyone I need to watch out for?”

“The team is fine. The interns are good, smart and hard working. The resident, Ward, I’m not so sure about him. He had good reviews last year, but he tends to cut corners and not give the patients a lot of thought.”

May nods. “And the patients?”

“Most of them are straightforward, but Mr. Leal is still something of a mystery. He had a stent placed six weeks ago, but he came in a few days ago with in-stent thrombosis. He says he was taking his Plavix, but I asked the residents to get the records. Something strange is going on. His cardiologist, Camilla Reyes, came all the way from Fairfax to see him earlier today.”

May raises an eyebrow. “Are you sure she came over to see him?”

He clears his throat awkwardly. “How did you know about that? That was after you left Hopkins.”

She smirks. “People talk.”

“By people do you mean Clint?” he asks. “Well anyway, that’s not why she came up here. She was yelling at the residents, trying to bully them into transferring him to Fairfax. She was very upset that I wouldn’t authorize it.”

“Hmm, that is strange. I’ll look into it.”

*****

All three of them are packing up their things to go home when the fax machine in their office starts spitting out pages.

Jemma rushes over to it. “Those must be Mr. Leal’s records.” She starts to grab them, but the machine is not finished. It continues printing out pages for several minutes until there is a stack several inches thick. She groans. “There must be hundreds of pages here.”

“Don’t worry, I’ll help you look through them after we get home,” Fitz says.

“Do you guys live together?” Daisy asks.

“Yes, we have an apartment not far from here,” Jemma says.

Daisy feels a little envious that they live together. She had thought living alone would be nice, but she is already tired of coming home to empty apartment every day. She is so busy with work that she has not really had time to decorate, and the apartment feels cold and uninviting.

“I could help too. We could order some food and make a party of it.”

Fitz and Jemma live in a small rowhouse just a few blocks away from the hospital. Unlike her, they have taken the time to hang pictures on the wall, and the living room is filled with comfortable-looking furniture and bookshelves.

“Your place is really nice,” Daisy says. “It’s homey.”

“Thank you,” Jemma says. “Would you like some tea?”

She makes tea while Fitz orders Indian food, and then three of them sit on the floor of the living with the records spread out in front of them.

Jemma frowns. “Most of these are just nursing notes.”

“Yeah, and every normal lab he’s ever had. How is this supposed to help?” Daisy asks.

“Coulson seems to think it’ll explain why his stent got clogged,” Fitz says.

“Okay, so what could make that happen?” Daisy asks.

“It’s probably because he stopped taking his Plavix. That’s what Ward thinks.” Fitz starts sorting the notes into two piles in front of him. “Maybe there’s something in here about him being noncompliant with his medications.”

“Or it could be because he has a genetic mutation that makes Plavix less effective. That could show up in his labs.” Jemma starts going through a pile of lab results.

Daisy looks at the remaining stack of nursing notes. “I guess I’ll look through these and see if I find anything useful.” Truthfully she does not even know what exactly she should be looking for. She cannot even remember exactly how long patients are supposed to take blood thinners after a stent is placed. She checks the date of his procedure. “He had his stent placed six weeks ago. Shouldn’t he have been done taking it by now?”

“He had a metal stent, so he needed one month of Plavix,” Jemma says.

“So then why is he sick now?”

Fitz shrugs. “Maybe the clot started forming a few weeks ago.”

“But that doesn’t fit the timeline of his symptoms,” Jemma says.

“Or he might not have recognized them right away.”

“Well I still think it could be a genetic mutation, but it doesn’t look like they screened him for that.”

Fitz rolls his eyes. “You know what they say -- when you hear hoofbeats, think horses, not zebras --”

“You know I hate that saying.” Jemma shoves some lab results at him. “See, his liver function tests were mildly elevated. He could have had a liver injury that affected the metabolism of the drug.”

While the two of them bicker, Daisy does her best to tune them out and focus on the mountain of paperwork in front of her. Most of it is handwritten, not typed, and some of it is difficult to read. As she is skimming over a procedural log, she sees something that makes her pause. “Hey Jemma, I thought you said he had a metal stent.”

“He did. Why?”

“Because this note says it was a drug stent. It says 10:42 - Drug stent placed.” She hands it to Jemma, and Fitz peers over her shoulder.

“Maybe the nurse made a mistake,” Fitz says, but he does not sound convinced.

Jemma looks thoughtful. “It is odd that it closed up so quickly. But if it were a drug stent instead of a metal stent --”

Fitz searches through the stack of nursing notes in front of him. “I know I saw a reference to a metal stent on one of these --”

Daisy sighs. Fitz and Simmons have known each other since medical school, and they always seem to know what the other one is thinking, but they almost never clue her in. “So what does that mean? Do drug stents close up more easily?”

“Drug stents stay open better in the long-term, but the patient has to take Plavix for a full year, not just a month,” Simmons explains.

Daisy frowns. “So if they put in a drug stent, but told the patient it was a metal stent and that he only needed a month’s worth of Plavix --”

“-- that would be a huge mistake,” Simmons says.

*****

When Fitz and Jemma arrive the next morning, Ward is working at the desk behind the office door. He beats them into the office every morning, and Jemma wonders if he ever goes home, or if he even has a home.

Jemma drops the armload of records onto the table with a satisfyingly loud thump. “Mr. Leal’s records came in yesterday evening. Fitz, Daisy, and I stayed up late going over them all.” Ward does not even look up from his computer, but Jemma presses on. “We found something strange in the records, although it could be just a clerical error, but --”

Ward turns to face them. “Just get to the point.”

Jemma hands him the key page they had discovered last night. “In all of his clinic notes, it says that he had a metal stent placed six weeks ago, and he was told to stop the Plavix two weeks ago, right on schedule. But this nursing note says that he had a drug stent placed.”

Ward studies the paper, then reaches for the rest of the records and silently flips through them.

Impatient, Fitz asks, “So what do we do now?”

“And how do we tell the patient?” Jemma adds.

“Tell the patient what?”

Everyone turns towards the doorway to see that Daisy and an older woman in a white lab coat have just arrived.

Ward says, “Dr. May, the interns found something in the records of the heart attack patient.”

“Should we page Coulson?” Daisy asks.

“Coulson is in meetings all day. I’m covering for him.” She looks at Ward. “What did they find?”

Ward hands her the records. “It looks like Dr. Reyes thought she put in a metal stent when it was actually a drug stent.”

May studies the records and nods.

“What do we do now?” Fitz asks.

“We tell the patient,” May says, “and we report this to her hospital as well. She shouldn’t have tried to cover it up.”

“How do you know she did that?” Jemma asks. “It could have been an honest mistake, like the nurse grabbed the wrong type of stent during the procedure, or something.”

May puts the notes on the table and points to the bottom of the page. The others crowd around her to see. “The time and date stamp here indicates every time someone made a change to the record. These notes were changed two days ago. She probably changed everything she could to look like he had had the bare metal stent all along. Have Fairfax General fax over earlier versions of these notes so we know what they used to say.”

Fitz, Jemma, and Daisy spend the next couple hours going through even more paperwork, but by the end of it they have even more proof that their theory about the stent mixup was correct, and that Dr. Reyes tried to cover it up after Mr. Leal had his heart attack. When Coulson comes by at the end of the day, they have a stack of all the relevant documents waiting for him.

“May filled me in on what happened with Mr. Leal’s stent,” Coulson says. “How did he take the news?”

It had been one of the most uncomfortable experiences of Jemma’s life. Fortunately, May and Ward had done all of the talking while she just listened. “Okay I guess, but he said he’s going to sue Dr. Reyes.”

“I’m not surprised. How is Mr. Leal doing?”

“He’s better today, off oxygen. Dr. May said he can go home tomorrow.”

“Good. You took good care of him.”

Jemma smiles. She has always been more interested in research than direct patient care, but it feels good knowing that they’ve really helped Mr. Leal.

Fitz looks pleased too, but Daisy looks concerned. “What’s going to happen to Dr. Reyes?”

“Dr. May contacted her hospital and told them what happened. She’s going to be suspended for a while, and there will be a hearing. She might end up losing her privileges.” He gives the interns a stern look. “Everyone makes mistakes, but what’s important is what you do next. If anything like this ever happens to one of you, you can always come to me or another attending. Don’t try to cover it up. It’ll only make it worse for you and the patient.”

They all nod vigorously.

Coulson turns to leave, but before he gets out the door, Daisy blurts out, “So what was up with you and Dr. Reyes anyway? Did you guys date or something?”

Jemma feels her face turn red, and Fitz stares at Daisy with her mouth open, but Coulson just looks amused. “That’s confidential.”


End file.
